Withdrawal symptoms have occurred following rapid decrease or abrupt discontinuance of alprazolam. These can range from mild dysphoria and insomnia to a major syndrome, which may include abdominal and muscle cramps, vomiting, sweating, tremor and convulsions. In addition, withdrawal seizures have occurred upon rapid decrease or abrupt discontinuation of therapy with alprazolam.
Anterograde amnesia may occur at therapeutic dosages and the risk increasing at higher dosages. Amnesic effects may be associated with inappropriate behaviour.
Pre-existing depression may be unmasked during benzodiazepam use.
Paradoxical reactions, eg stimulation, agitation, concentration difficulties, confusion, hallucinations or other adverse behavioural effects, may occur in rare instances and in a random fashion. They are more likely to occur in children and the elderly. Patients who have borderline personality disorder, a prior history of violent or aggressive behaviour, or alcohol or substance abuse may be at risk of adverse behavioural effects. Instances of irritability, hostility and intrusive thoughts have been reported during discontinuance of alprazolam in patients with post-traumatic stress disorder.
Use of alprazolam (even at therapeutic doses) may lead to the development of physical dependence. Discontinuation of the therapy may result in withdrawal or rebound phenomena. Psychic dependence may also occur.
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